Expanding the ECLO service

Post date:

Wednesday, 22 February 2017

Eye Clinic Liaison Officers play a crucial role in supporting people who have recently been diagnosed. At a time when services are more squeezed than ever before, how can the service be maintained and expanded?

Early intervention and support is one of the most important, and most valued things that can be offered to anyone who is coming to terms with losing their sight. Eye Clinic Liaison Officers (ECLOs) or Vision Support Officers in Scotland – provide that service; they’re the people whose job it is to listen to patients talk after they’ve had a sight loss diagnosis, help them find their way forward, and give them the emotional and practical support that they need. It’s a service that is widely appreciated by everyone, from patients to ophthalmology consultants.

RNIB is calling for every eye department in the UK to have access to an ECLO, for these to be recognised as an essential part of every eye department’s team and for them to be funded on a permanent basis.

A quality investment

Action for Blind People and RNIB (which combined their services in 2007) also run a team specifically charged with expanding and sustaining the ECLO service around the UK. All the ECLOs they put in place should be working to the quality framework developed by RNIB, which includes a four-day course accredited by City University London. “When we go out and sell an ECLO, we are also selling a quality standard,” says Tom Reck, head of business development at Action for Blind People. “We have robust evidence and service income documents.”

RNIB research published in 2014 looking at one ECLO service pointed to some of the outcomes that stem from providing an ECLO of this quality: overall patients felt that having an ECLO had directly improved their overall well-being and their independence in the home. These ‘soft’ outcomes are not the only ones – there is also a direct return on investing in the ECLO: £1 can net a return of £10.57 to health and social care expenditure budgets and £4.92 to health, social care and welfare expenditure budgets.

However, that investment still requires the money to put into it in the first place. And at the moment, hospitals and local authorities are struggling to cover their existing costs: putting new staff into place, however important, is often the last thing on their minds. Reck and his team now have a budget which enables them to part-fund the first couple of years of an ECLO post, at an agreed rate, before the hospital takes on the full responsibility.

This is a hard-headed business decision, Reck points out. “We’re not parachuting in with RNIB cash. We always insist on some kind of co-funding and our quality standards; we embed the service, and they start to see its benefits. This isn’t business development in isolation; it is part of a project to grow and sustain ECLO provision, because sustaining the service is as important as growing it. And with the contracts we sustain, we’re also eventually attracting income.”

Getting other partners on board

The sliding scale of investment has made it possible to agree different types of funding arrangements – including bringing local donors on board. Not all the ECLOs this team puts in place are provided directly by Action for Blind People (or RNIB in Scotland, Wales and Northern Ireland). A significant number are provided by other local charitable organisations or occasionally by the NHS itself. Most of these organisations are working to the RNIB quality framework and practice guidance already, with RNIB and Action For Blind People making great efforts to get those standards agreed across the board.

“For example, we met with the CEO of Norwich and Norfolk Association for the Blind and found they’d already put some advisory services into one of the local hospitals. We agreed to match-fund those ECLOs as long as they were upgraded to the RNIB standards. So for the same amount of investment, the association has our training, and we’re making a joint approach to the NHS trust to talk about their contribution too.”

Getting ECLOs where they are needed

The project has mapped the provision of RNIB-approved ECLOs, in order to identify where the gaps are. “If we put an ECLO in the 100 most-used eye departments across England, we’ll get access to over 90 per cent of people who were recently diagnosed with sight loss. We know where we need to go first, so we’re targeting our growth. By the end of March 2017 we should have covered around 75 of these departments," says Reck. "There will be more in Scotland, Wales and Northern Ireland, though the overall numbers will be smaller to reflect the lower number of people with visual impairment.

And with each new position an average of 500 new people gain the service of an ECLO. “We’re prepared to put money in at the beginning, to get traction and get them adopting the standards. We don’t want one-year deals. We’re in this for the long haul.”

Supporting the service with volunteers

ECLOs are fully-trained professionals, but there’s also scope for supporting them with volunteers. RNIB and Action for Blind People are piloting a volunteer scheme in this area. In addition, Moorfields Eye Hospital’s East site, which covers six locations across east London, has introduced a model where the one full-time ECLO is supported by at least 20 emotional support volunteers recruited by the Thomas Pocklington Trust.

“It’s not feasible to have an ECLO at every site,” says Tracy Luckett, who is the director of nursing and allied health professions at Moorfields Eye Hospital NHS Foundation Trust. “The volunteers don’t have full ECLO training but there’s a full recruitment and selection process. Prior to starting at the trust, the newly appointed emotional support volunteers undertake a robust training programme. They offer help in a variety of ways, such as providing patient information, sitting down and talking to patients about their general health, and offering support in clinic. They’ll also signpost patients to additional services. It is cost-effective because we’re still providing the ECLO as well as volunteers with a range of different skills.”